Individual provider Active NPI

John Melton Bennett, MD, MPH

  • Family Medicine Physician
  • Berea, KY
National Provider Identifier
1851328074
Registry record updated Apr 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30690 Issued in KY
Practice address
209 Pauline Dr
Berea, KY 40403-8889
Phone
(859) 233-4511
NPI assigned
Jun 26, 2006
Last updated
Apr 3, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 30690 KY
Family Medicine Physician 207Q00000X 30690 KY Primary
Adolescent Medicine (Family Medicine) Physician 207QA0000X 30690 KY
Adult Medicine Physician 207QA0505X 30690 KY
Geriatric Medicine (Family Medicine) Physician 207QG0300X 30690 KY

Addresses

Primary practice location

209 Pauline Dr
Berea, KY 40403-8889

Mailing address

1101 Veterans Dr
Berea Cboc
Lexington, KY 40502-2235
Phone (859) 233-4511

Other identifiers 1

IdentifierTypeStateIssuer
64306905MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213000541 KY Practitioner - Emergency MedicinePractitioner - Family Practice 0840256996 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Dec 16, 2013 Accepting new patients

Locations

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

1140 Lexington Rd
Ste 203
Georgetown, KY 40324
Phone (502) 570-3757

60 Mercy Ct
Irvine, KY 40336
Phone (606) 723-2115

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

360 Amsden Ave
Versailles, KY 40383
Phone (606) 873-3111

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428019200000",
    "number": "1851328074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 VETERANS DR",
            "address_2": "BEREA CBOC",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405022235",
            "telephone_number": "859-233-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 PAULINE DR",
            "city": "BEREA",
            "state": "KY",
            "postal_code": "404038889",
            "telephone_number": "859-233-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JOHN",
        "middle_name": "MELTON",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2015-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "30690",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "30690",
            "primary": true
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "KY",
            "license": "30690",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "KY",
            "license": "30690",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "KY",
            "license": "30690",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64306905",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berea, KY

Sources for this page

Verify at the official NPI Registry.